The U.K. Understands How To Treat PTSD. Why Does The U.S. Lag Behind?

New research on soldiers returning from Iraq and Afghanistan

February 28, 2014

A recent study claims that despite similar experiences in Afghanistan and Iraq, U.K. soldiers on average report better mental health than U.S. soldiers. King’s College London researchers analyzed 34 studies produced over a 15-year period and found that overall there has been no increase in mental health issues among British personnel—with the exception of high rates of alcohol abuse among soldiers. The study was in part inspired the “significant mental health morbidity” among U.S. soldiers and reports that factors such as age and the quality of mental health programs contribute to the difference between the two nation’s servicemen and women.

Post-traumatic stress disorder afflicts roughly 2 to 5 percent of non-combat U.K. soldiers returning from deployment, while 7 percent of combat troops report PTSD. According to a General Health Questionnaire, an estimated 16 to 20 percent of U.K. soldiers have reported symptoms of common mental disorders, similar to the rates of the general U.K. population. In comparison, the authors say recent studies show U.S. soldiers experience PTSD at rates of 21 to 29 percent. The U.S. Department of Affairs estimates PTSD afflicts 11 percent of veterans returning from Afghanistan and 20 percent returning from Iraq. Major depression is reported by 14 percent of major soldiers according to study commissioned by RAND corporation; roughly seven percent of the general U.S. population reports similar symptoms.

“While it is difficult to compare rates between nations, a consistent finding of the last 20 years is that reported mental health problems tend to be higher among service personnel and veterans of the USA compared with the UK, Canada, Germany and Denmark,” wrote study author Dr. Deirdre MacManus.

Why the difference? The authors point to multiple possibilities. One factor is that U.S. soldiers are more likely than their U.K. counterparts to be from the reserve forces; empirical studies show reservists from both U.S. and U.K. troops are more likely to experience mental illness post-deployment. U.S. soldiers also tend to be younger—untested personnel who are more vulnerable to mental illness. In contrast, the elite forces of the U.K. military, such as the Royal Marines and Airborne personnel, were found to be the least affected by mental illness.

“In spite of elite forces experiencing some of the toughest fighting conditions, they tend to enjoy better mental health than non-elite troops,” says study author Dr. Neil Greenberg, a professor of defense mental health. “It’s also worth pointing out that these troops also have very good levels of camaraderie, and we know that social cohesion in military units is also psychologically protective.”

Another important factor is the difference between the length of tours—U.S. troops are often deployed twice as long as U.K. forces.

“There is a substantial amount of evidence that longer tours are linked with poorer mental health,” says Greenberg. “It’s clear that if you tell someone they will be deployed for nine months and then they end up being deployed for 12, their mental health is very much negatively affected.”

Greenberg also credits the U.K.’s military mental health efforts, the Trauma Risk Management program (TRiM) and the practice of soldiers spending time in a “third location decompression” (TLD), as important tools for British soldiers to process their experiences. Used by the Armed Forces since 2007, TRiM is a peer support system designed to assess trauma experienced by soldiers and encourage them to seek help if needed. TLD requires members of the armed forces to spend 36 hours in a location away from combat before returning home, often on the bases in Cyprus within the British Sovereign Territory there. Both of these mitigation measures focus on unit cohesiveness, which is proven to be associated with lower levels of common mental disorders and PTSD.

“The aim of decompression is to ensure everyone gets a proper mental health briefing and that they are able to speak informally to each other without being shot at,” says Greenberg. “This is an opportunity to access social support and begin the reintroduction to ‘normal life.’”

Programs like TRiM and TLD are not routinely used by the U.S. military, but the study authors say U.S. senior command is in the process of considering whether the practices would be useful for their personnel.

This examination of U.K. soldiers coincides with the newly reopened debate over the effectiveness of U.S. military mental health programs. Earlier this month, at the request of the Pentagon, a panel of experts appointed by the Institute of Medicine of the National Academies released a report claiming that despite the availability of dozens of mental health programs and the millions spent on their implementation, there is little evidence that they work. Inconsistencies in care availability, quality, and a lack of systemic evaluation were listed by the IOM as evidence of a failing system.

The Army has refuted these findings, claiming their own research proves otherwise. But the numbers still stand; British soldiers are being provided something that American’s aren’t. Maybe it’s time we take note from our neighbors across the pond and provide our soldiers with the effective, supportive mental health programs that they need.